Dancer's Name

First Name

Last Name

Mailing Address

City

Zip

Parent Phone Number

(###)

###

####

Dancer's Birthday

YYYY

Dancer's Age

School Name

Grade in School

Parent/Guardian Information

Name of the Person/Parent/Guardian Dancer Lives With

First Name

Last Name

Address (if different from above)

City (if different from above)

Zip (if different from above)

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Parent Email

Emergency Contact Information

Emergency Contact Name

First Name

Last Name

Relationship

Emergency Contact Phone Number

(###)

###

####

Additational Information

Names of other family members in dance

Please list any medical conditions the dancer has

Student Pick up (if any)

Classes and Payment

List the classes that you are registering for

Annual enrollment fee of $25, Please select your method of payment.

I will call the studio with my credit card information.

I will bring payment into the studio during open enrollment.

Enrollment

Registration Form